Evidence based selection of hearing aids and features

Evidence based selection of hearing aids and features Mark Laureyns Thomas More University College Department of Audiology Antwerp CRS - Amplifon Centre for Research & Studies Milan Italy European Association of Hearing Aid Professionals Brussels - Belgium 1

What is the basis for selection? Symmetric Hearing Loss Good Localisation (Central Auditory Processing) Poor Localisation (Central Auditory Processing) Asymmetric Hearing Loss One Normal Ear One Aidable Ear (Mono-Stereophony) Asymmetric Aidable Hearing Loss in both ears Single Sided Deafness - One Un-Aidable Ear

Left-Right and Front-Back Spatial Hearing with Multiple Directional Microphone Configurations in Modern Hearing Aids Carette et al. 2014 Can symmetric hearing loss lead to localisation problems? Normal Hearing Subjects Hearing Impaired Subjects Symmetric Hearing Loss can result in Poorer Localisation

Left-Right and Front-Back Spatial Hearing with Multiple Directional Microphone Configurations in Modern Hearing Aids Carette et al. 2014 Do Hearing Aids impact localisation in symmetric hearing loss? >< >< Directional Systems can result in Good or Poor Localisation

Traditional Fixed Directionality + Improves SNR by 3 db - Low Frequency Roll Off Wind Noise Problems Noise (when using bass boost) 6

Adaptive Directionality + Impressive effect at first experience (realistic 3 db SNR Improvement) 2600 Hz - 195 1900 Hz - 160 3300 Hz - 230 1200 Hz - 270 - Low Frequency Roll Off Wind Noise Problems Noise (when using bass boost) Left-Right Localisation Problems Aggressive Processing 500 khz - 180 90 0 7

Horizontal localization with bilateral hearing aids Adaptive Directionality in Hearing Aids Leads to Localisation Problems Omni is better Unaided is better Adaptive Directionality results in Localisation Problems 8

Directional Microphone Configurations and Orientation Adaptive Directionality in Hearing Aids Leads to Orientation Problems Omni is better Adaptive Directionality results in Orientation Problems 9

In a double blind study, forced-choice design, 23 participants (hearing aid users) were asked to choose the program they judged as having the best sound quality (for Music-Speech-Environmental sounds). Groth, Laureyns, 2010 Traditional Fixed and Adaptive Directionality The Roll-Off consequences P1: Omni P2: No BassBoost P3: BassBoost + Good Audibility + Low Noise + Low Noise - Reduced Audibility lost low frequencies + Good Audibility - High Noise bass noise-floor Omni No Bass boost Bass Boost Traditional Directionality results in Poor Sound Quality 10

Asymmetric Directionality + Better Sound Quality Keep low frequencies at omni side No need to switch 3dB SNR Improvement - Left-Right Localisation Problems 11

Pinna Directionality + Better Sound Quality Very natural experience Keep low frequencies No need to switch Good localisation both Left- Right and Front-Back 3 db SNR Improvement - Less impressive at first demo Open human ear Pinna Directionality 12

In a double blind study, forced-choice design, 23 participants (hearing aid users) were asked to choose the program they judged as having the best sound quality (for Music-Speech-Environmental sounds). Groth, Laureyns, 2010 Sound Quality Double Blind Study Bass Boost <>Pinna Dir. Pinna Dir. Pinna Dir. Pinna Directionality results in the best sound quality 13

Directional Microphone Configurations & Localisation Pinna Dir. Pinna Dir. 14

Directional Microphone Configurations & Localisation

Directional Microphone Configurations & Left-Right Localisation 0 P = 0.008* 15-90 No significant difference between omni and unaided, P = Human 0.043* ear like and competition * Competition* performs significantly worse than unaided (p= 0.035) 90 * The competitive system was using Ear 2 Ear to improve Left-Right localization Pinna Dir. Pinna Directionality and Omni result in the best left/right localisation

Directional Microphone Configurations & Front-Back Localisation P = 0.001* P = 0.009* competitive system was using a microphone mode to improve front to back localization Pinna Dir. Pinna Directionality results in the best front/back localisation

What is the basis for selection? Symmetric Hearing Loss Evaluate Localisation Performance Test or Questionnaire (SSQ) Good Localisation (Central Auditory Processing) Select directionality that preserves localisation ques (Pinna Directionality is now available in all major hearing aid brands but is rarely default) Ensure good balance between both ears Evaluated aided localisation performance (and compare to unaided) Poor Localisation (Central Auditory Processing) Evaluate if poor localisation could be caused by earlier hearing aid selection or fitting. Here you can use more aggressive directionality Consider accessories remote microphone FM systems (up to 20 db SNR Improvement)

What is the basis for selection? Asymmetric Hearing Loss One Normal Ear One Aidable Ear (Mono-Stereophony) The goal is to restore natural binaural hearing & localisation Ensure good aided balance between both ears don t use the fitting formula but use localisation or balance test Select directionality that is comparable to the real ear performance (Pinna Directionality is now available in all major hearing aid brands but is rarely default) Use little or no noise reduction this leads to unbalance between the ears Evaluated aided localisation performance (and compare to unaided)

What is the basis for selection? Asymmetric Hearing Loss restore binaural masking release Laureyns et al, 2017 30 Young Normal Hearing Subjects Avg Age 22y 70% female 20 Control Subjects (Gender/Age) Avg Age 73y 67% female 20 Hearing Instrument Users Avg Age 73y 67% female

What is the basis for selection? Asymmetric Hearing Loss Asymmetric Aidable Hearing Loss in both ears The goal is to restore natural binaural hearing & localisation Ensure good aided balance between both ears only use the fitting formula at the start for the worst ear - use localisation or balance test to fine-tune. When the worst ear was not aided for a long time, allow time for habituation and repeat balance test systematically. If speech intelligibility on the worst ear is poor, you may fit this ear as a noise reference ear (to support binaural masking release)

What is the basis for selection? Asymmetric Hearing Loss Single Sided Deafness - One Un-Aidable Ear CROS Transcranial Cros Hearing Aids Bone Anchored CI Cochlear Implant on the unaidable ear

Single Sided Deafness and CROS EAR & HEARING, VOL. 37, NO. 5, 495 507 (2016) Conclusions: Devices that reroute sounds from an ear with a severe to profound hearing loss to an ear with minimal hearing loss may improve speech perception in noise when signals of interest are located toward the impaired ear. However, the same device may also degrade speech perception as all signals are rerouted indiscriminately, including noise.

Single Sided Deafness and Cochlear Implants Patients with a shorter duration of deafness were more likely to improve in listening conditions that created a less favourable SNR at the implanted ear than the non-implanted ear. Those with more residual hearing in the better ear were more likely to improve in the listening condition that created a less favourable SNR at that ear. Conclusions: The data reveal significant improvement in speech perception performance in quiet and in noise in patients with single-sided deafness after implantation.

Single Sided Deafness and Cochlear Implants Although cochlear implant is not a Food and Drug Administration-approved treatment for SSD, several recent studies show improvements in speech understanding, sound localization, and tinnitus. Tokita et al. Curr Opin Otolaryngol Head Neck Surg 2014, 22:353 358

What is the basis for selection? Asymmetric Hearing Loss Single Sided Deafness - One Un-Aidable Ear CROS Transcranial Cros Hearing Aids Bone Anchored The goal is to reduce the head shadow effect CROS improves the situation if speech is on the deaf side and noise on the good side. CROS makes things worse, if speech is on the good side and noise on the deaf side. Classification or Noise Reduction may reduce the negative effects YOU CAN NOT IMPROVE LOCALISATION! CI Cochlear Implant on the unaidable ear This can improve localisation (next to communication and tinnitus) But mostly not seen as a cost-effective intervention (for now )

Conclusion >< Natural >< Aggressive In binaural fitting localisation is essential Evaluate Localisation both unaided and aided When localisation is possible, select natural features that preserve localisation cues. Watch out for aggressive signal processing Pinna Directionality preserves localisation cues and sound quality. For mono-stereophony Avoid Noise Reduction Only Human Ear Like Directionality Fitting needs to be based on balance not on the default gain formula Don t go for quick fit or default go for personalised quality hearing care.

Evidence based selection of hearing aids and features Mark Laureyns Thomas More University College Department of Audiology Antwerp - Belgium CRS - Amplifon Centre for Research & Studies Milan Italy European Association of Hearing Aid Professionals Brussels - Belgium 29